Epidemiology and management of proximal tibia frac-tures in children and adolescents : a population-based study based on the Kids? Fracture Tool

Background and purpose - Proximal tibial fractures are infrequent injuries in children, and the literature on epi-demiology, associated injuries, and management is limited. We calculated a population-based incidence and described the characteristics of proximal tibial fractures in children in terms of complications and management.Patients and methods - This is a retrospective study over a 6-year-period during including 241 children with proximal tibial fractures who presented to our university hospital. Demographic and fracture-related data was col-lected from the Kids' Fracture Tool. The number of children during the study period was collected from statistical year-books of the City of Helsinki to estimate annual incidence.Results - Extra-articular fractures (129/241) peaked at the age of 3 and tibial tubercle (42/241) and intra-articular fractures (70/241) peaked at the age of 15. Annual incidences were estimated to be 3.4/100,000 children and 22/100,000 children in the age group of 13-16 years for ACL avulsions, and 3.8/100,000 children and 21/100,000 children in the age group of 13-16 years for tibial tubercle fractures. The inci-dence of vascular compromise (0%) and compartment syn-drome was low (0.4 %, 1/241).Conclusion - Proximal tibial fractures present with a bimodal distribution, with extra-articular fractures peaking at the age of 3 years and fractures of the tibial tuberosity and intra-articular fractures peaking at the age of 15 years. Additionally, associated compartment syndrome and vascu-lar compromise was not as common as previously reported.Peer reviewe

Sex-driven variability in TSPO-expressing microglia in MS patients and healthy individuals

Background: Males with multiple sclerosis (MS) have a higher risk for disability progression than females, but the reasons for this are unclear.Objective: We hypothesized that potential differences in TSPO-expressing microglia between female and male MS patients could contribute to sex differences in clinical disease progression.Methods: The study cohort consisted of 102 MS patients (mean (SD) age 45.3 (9.7) years, median (IQR) disease duration 12.1 (7.0–17.2) years, 72% females, 74% relapsing–remitting MS) and 76 age- and sex-matched healthy controls. TSPO-expressing microglia were measured using the TSPO-binding radioligand [11C](R)-PK11195 and brain positron emission tomography (PET). TSPO-binding was quantified as distribution volume ratio (DVR) in normal-appearing white matter (NAWM), thalamus, whole brain and cortical gray matter (cGM).Results: Male MS patients had higher DVRs compared to female patients in the whole brain [1.22 (0.04) vs. 1.20 (0.02), p = 0.002], NAWM [1.24 (0.06) vs. 1.21 (0.05), p = 0.006], thalamus [1.37 (0.08) vs. 1.32 (0.02), p = 0.008] and cGM [1.25 (0.04) vs. 1.23 (0.04), p = 0.028]. Similarly, healthy men had higher DVRs compared to healthy women except for cGM. Of the studied subgroups, secondary progressive male MS patients had the highest DVRs in all regions, while female controls had the lowest DVRs.Conclusion: We observed higher TSPO-binding in males compared to females among people with MS and in healthy individuals. This sex-driven inherent variability in TSPO-expressing microglia may predispose male MS patients to greater likelihood of disease progression.<br/

Invasive species control with apex predators : increasing presence of wolves is associated with reduced occurrence of the alien raccoon dog

The role of an alien predator in the community depends on its interaction with native predators. The absence of apex predators may facilitate outbreaks of invasive mesopredators, but the effect of apex predators may vary between species and environments. We analysed the occurrence of a common invasive mesopredator in Europe, the raccoon dog (Nyctereutes procyonoides), and native mesopredators, the red fox and the Eurasian badger, in camera-trap data from Finland. The observations in cameras were analysed in relation to the presence of apex predators in the landscape (grey wolf and Eurasian lynx), human density, and habitat. We observed negative effect of increasing presence of wolves and lynxes on the occurrence of raccoon dogs. This effect appeared clear compared to the effects of habitat and human density. The effect of lynxes on raccoon dogs was clearer in areas with short growth season. For the occurrence of badgers, the presence of wolves had a weak negative effect and the presence of lynxes had a positive effect. For the occurrence of red foxes, wolves had a positive effect when agricultural fields were sparse in the landscape and lynxes had no effect. We also observed that the invasive raccoon dog currently appears to be the most common mesopredator within the study area. We conclude that the effect of apex predators on mesopredators depends on the environment and, in our case, was more suppressive on the alien mesopredator than on the native mesopredators. Thus, apex predators can play an important role in controlling invasive mesopredators.Peer reviewe

High serum neurofilament associates with diffuse white matter damage in MS

Objective To evaluate to which extent serum neurofilament light chain (NfL) increase is related to diffusion tensor imaging-MRI measurable diffuse normal-appearing white matter (NAWM) damage in MS.Methods Seventy-nine patients with MS and 10 healthy controls underwent MRI including diffusion tensor sequences and serum NfL determination by single molecule array (Simoa). Fractional anisotropy and mean, axial, and radial diffusivities were calculated within the whole and segmented (frontal, parietal, temporal, occipital, cingulate, and deep) NAWM. Spearman correlations and multiple regression models were used to assess the associations between diffusion tensor imaging, volumetric MRI data, and NfL.Results Elevated NfL correlated with decreased fractional anisotropy and increased mean, axial, and radial diffusivities in the entire and segmented NAWM (for entire NAWM ρ = −0.49, p = 0.005; ρ = 0.49, p = 0.005; ρ = 0.43, p = 0.018; and ρ = 0.48, p = 0.006, respectively). A multiple regression model examining the effect of diffusion tensor indices on NfL showed significant associations when adjusted for sex, age, disease type, the expanded disability status scale, treatment, and presence of relapses. In the same model, T2 lesion volume was similarly associated with NfL.​​​​​​​Conclusions Our findings suggest that elevated serum NfL in MS results from neuroaxonal damage both within the NAWM and focal T2 lesions. This pathologic heterogeneity ought to be taken into account when interpreting NfL findings at the individual patient level.</p

Insights into disseminated MS brain pathology with multimodal diffusion tensor and PET imaging

Objective To evaluate in vivo the co-occurrence of microglial activation and microstructural white matter (WM) damage in the MS brain and to examine their association with clinical disability.Methods 18-kDa translocator protein (TSPO) brain PET imaging was performed for evaluation of microglial activation by using the radioligand [11C](R)-PK11195. TSPO binding was evaluated as the distribution volume ratio (DVR) from dynamic PET images. Diffusion tensor imaging (DTI) and conventional MRI (cMRI) were performed at the same time. Mean fractional anisotropy (FA) and mean (MD), axial, and radial (RD) diffusivities were calculated within the whole normal-appearing WM (NAWM) and segmented NAWM regions appearing normal in cMRI. Fifty-five patients with MS and 15 healthy controls (HCs) were examined.Results Microstructural damage was observed in the NAWM of the MS brain. DTI parameters of patients with MS were significantly altered in the NAWM compared with an age- and sex-matched HC group: mean FA was decreased, and MD and RD were increased. These structural abnormalities correlated with increased TSPO binding in the whole NAWM and in the temporal NAWM (p Conclusions Widespread structural disruption in the NAWM is linked to neuroinflammation, and both phenomena associate with clinical disability. Multimodal PET and DTI allow in vivo evaluation of widespread MS pathology not visible using cMRI.</div

Oman elämänsä herrat : Neljän viikon kurssi nuorille syrjäytyneille miehille

Opinnäytetyön tarkoituksena oli suunnitella neljän viikon mittainen kurssi nuorille syrjäytyneille miehille, joilla on mielenterveys- ja päihdeongelmia. Opinnäytetyössä perehdyttiin siihen mitä mielenterveys- ja päihdekuntoutus pitää sisällään, mitä on syrjäytyminen ja miten syrjäytymistä voidaan ehkäistä. Lisäksi selvitettiin mitä kurssisuunnitelman täytyy sisältää. Opinnäytetyön menetelmäksi valittiin toiminnallisen menetelmän, koska tehtiin tuotos eli kurssisuunnitelma. Mielenterveys- ja päihdeongelmilla, koulun keskeyttämisellä ja työttömyydellä on selkeä yhteys syrjäytymiseen. Syrjäytymistä voidaan ehkäistä kannustamalla nuoria kouluttautumiseen, ohjaamalla nuoria työelämään, sekä tunnistamalla syrjäytymisvaarassa olevat nuoret. Nuorten mielenterveys- ja päihdekuntoutuksen tulisi keskittyä arkielämän hallintaan, keskenjääneiden elämänprojektien käynnistämiseen ja kuntoutuksen pitäisi olla suunnitelmallista. Nuorilla ryhmämuotoinen kuntoutus on todettu tehokkaaksi. Kirjallisuuskatsauksen perusteella tehtiin kurssisuunnitelma, joka sisälsi elämänhallintaan, terveyteen ja päihteiden käyttöön sekä elämänprojektien käynnistämiseen liittyviä osa-alueita. Tulevaisuudessa toivotaan, että kurssia toteutettaisiin nuorten syrjäytyneiden miesten auttamiseksi työelämäyhteydessä ja mahdollisesti myös muualla Suomessa. Kehitysehdotuksena vastaavanlaisia kursseja voisi suunnitella myös nuorille naisille ja tutkia nuorten naisten syrjäytymistä.The aim of this study was to plan a course for young men suffering from social exclusion, mental problems and problems with intoxicant abuse.The goal was to find out 1) what mental rehabilitation and rehabilitation from substance abuse consist of, 2) what social exclusion is and how it can be prevented, and 3) how to plan the course and what it should include. The study was output-oriented, as a course plan was also made. Mental problems, problems with substance abuse and unemployment have a connection to social exclusion as well as dropping out from school. Social exclusion can be prevented by encouraging young men to educate themselves and help them find their way to the working life. To identify the signs of becoming socially excluded is important. Rehabilitation of persons with mental problems and problems with substance abuse should focus on controlling life, restarting life projects and the rehabilitation should be planned. For the young, rehabilitation in a therapeutic group is effective. A program for the course was made on the basis of literature and studies. The course includes fields of life control, health and drug abuse and restarting life projects. It is hoped that the program will be used in the working life and in the whole country to rehabilitate young men dealing with social exclusion. In addition, social exclusion with young women should be studied and similar courses for young women could be planned

Sisältä sanoiksi : Tunnekortit teini-ikäisille

Tämä opinnäytetyö on tutkimuksellinen kehittämistyö, jonka tuotoksena syntyi tunnekortit teini-ikäisille puheeksi ottamisen ja sanoittamisen tueksi. Opinnäytetyön tavoitteena oli tee-mahaastattelulla selvittää perhetyön toiveet ”unelmien tunnekorteista”. Teemahaastattelus-sa esiin nousi toive nuorten näköisistä korteista. Toiveena oli myös se, että kortit voitaisiin jakaa positiivisiin, negatiivisiin ja neutraaleihin sanoihin, jotta pakasta olisi helppo löytää tarvittavan kategorian kortit. Lastensuojeluyksikössä asuvat nuoret sanoittivat ja kuvittivat kortit ryhmänohjaustunneilla. Kenttätyöskentelyvaiheessa opinnäytteen painopisteeksi muodostui puheeksi ottamisen keinot ja siinä tukeminen. Nuorten näkökulma tuli esiin kort-tien aiheissa, tunnesanoissa ja kuvallisessa ilmaisussa. Kortteja painettiin 46 kappaletta, ja ne jaoteltiin värikoodein haastattelussa esiin tulleiden toiveiden mukaisesti. Opinnäytetyön teoreettisen viitekehyksen käsitteet ovat tunteet, tunnetaidot ja tunnekortit puheeksi ottamisen sekä sanoittamisen apuna. Teini-ikä on nuorille tunnemyrskyjen aikaa. Tunnereaktioiden ja tunnetaitojen hallitseminen ovat niitä taitoja, joita nuoruudessa harjoitellaan tasapainoista aikuisuutta varten. Nuorten kanssa työskenteleville ammattilaisille haasteiksi muodostuu usein se, osaavatko nuoret sanoittaa ja eritellä tunteitaan, ja miten vaikeita asioita voidaan ottaa nuorten kanssa pu-heeksi. Hyvät tunnetaidot ehkäisevät syrjäytymistä. Ihminen, joka osaa tunnistaa omia -ja toisten- tunteita ja niihin liittyviä syitä ja seurauksia, kykenee parempaan vuorovaikutukseen muiden ihmisten kanssa. Tunnetaitoja voidaan opettaa, ja tunnetyöskentelyyn onkin kehitetty erilai-sia tunnemenetelmiä, joista tässä opinnäytetyössä esitellyt tunnekortit ovat yksi esimerkki. Valmiit kortit tulivat myyntiin ammattikäyttöön. Ne sopivat niille eri tahoille, jotka työskente-levät nuorten parissa lastensuojeluyksiköissä, perhetyössä, nuorisotyössä, kuraattoreille ja muille ammattilaisille. Korttien käyttöön on monia eri variaatioita ja korttipakan mukana tulee myös käyttöohjeet